Questions about path and staging in multifocal

I read the 2005 study in the journal of clinical oncology.  I think the conclusion was that not considering the total tumor burden may under stage tumors.  The authors proposed an alternative staging scheme that measures the aggregate dimensions of all tumors in order to allow clinicians to compare axillary staging and treatment outcomes with similar size unicentric tumors.  That is a bit different than saying the tumor size should be combined to make sure the patient gets adequate adjunctive treatment.

Everything other article I've read says that combined tumor diameter in multi centric cancer should not be used for staging as it is not a good prognostic indicator.  I don't know - intuatively it that doesn't make sense to me.  

Here is the what I think:  I had two invasive tumors, one was 0.8 cm and the other was 1.2 cm.   The smaller one was about 50% er/pr positive.  The larger one was 99% er/pr positive.  Both were HER2 negative.  So it seemed clear to me they were separate tumors and each had a certain chance of recurring.  I insisted on oncotype scores for both tumors and looked at the change that either would recur.  The larger one had a 6% change of recurrence and the smaller one had a 10% chance of recurrence.   I talked with a friend (stats professor) who gave me the formula to determine the chance that I would have a recurrence.  It worked out to be slightly under 16%.  Still low enough that I felt comfortable not having chemo.

My onc had recommended chemo after my mast, but when I handed him a paper showing him my estimates of the benefits of chemo and how it would effect my chances of recurrence he didn't argue with me.  He wanted a copy for my file.

 I've read that multi centric cancers are rare, but I believe with the increased use of MRIs more women will be diagnosed with multi centric cancers.  I agree with the authors of the 2005 journal article - more studies are needed.

11/6/09 edited to correct:  my tumors were HER2 negative.   

If my memory serves me correctly, the largest focus of invasive cancer is used for the staging as well as the lymph node status. I don't believe any protocol adds the foci of IDC, but your doctor will know better. As to the DCIS, that is not included in the stage.

I was multi-focal too, with lots of DCIS and margins involved except inferiorly. 

If you want to find more on this of course BC.org may have the intricacies of staging, and you might reference the NCCN Guidelines or NIH Breast Cancer Diagnosis and Treatment Guidelines.

Good news on negative nodes. Mine snuck in when we weren't looking.

Best,

Tender